Glossary
of common Texas Insurance Terms

Texas
Insurance Terms

AAccelerated Death Benefits
- If your policy has an accelerated death benefits provision, it will
pay you - under certain conditions - all or part of the policy death
benefits while you are still alive. These conditions include proof that
the policyholder is terminally ill with a life expectancy of less than
12 months, has a specified life-threatening disease or is in a long-term
care facility such as a nursing home. If you have a group term life
policy or certificate, the amount of accelerated benefit you may receive
is limited by law to: the greatest of $25,000 or 50% of the death benefit.
By accepting an accelerated benefit payment, a person could be ruled
ineligible for Medicaid or other government benefits. The proceeds also
may be taxable.

Accidental Death Benefits
- If a policy includes an accidental death benefit, the cause of death
will be examined to determine whether the Insured´s death meets
the policy´s definition of accidental.

Actual Cash Value (ACV)
- The value of your property, based on the current cost to replace it
minus depreciation.

Adjuster - A
person who investigates and settles insurance claims.

Administrative Expense
Charge - An amount deducted, usually monthly, from the policy.

Agent - A person
who sells insurance policies.

Annuitant -
A person who receives the payments from an annuity during his or her
lifetime.

Annuity - A
contract in which the buyer deposits money with a life insurance company
for investment. The contract provides for specific payments to be made
at regular intervals for a fixed period or for life.

Annuity Certain
- An annuity that provides a benefit amount payable for a specified
period of time regardless of whether the annuitant lives or dies.

Annuity Period
- The time span between the benefit payments made under an annuity contract.

Application
- A form you fill out with information about you that an insurance company
will use to decide whether to issue you a policy and how much to charge.

Assignment -
The transfer of all or part of a policy owner´s legal title and
rights to a policy to another person. It is possible to change this
type of transfer at a later date.

BBankdraft
- Occurs when money is being automatically debited from a banking account
to for insurance coverage.

Benchmark Rate(s)
- The rates set annually by the Commissioner of Insurance that rate-regulated
insurance companies use to reference their rates. Rate-regulated insurance
companies filing rates within a range of 30 percent above or below the
benchmarks may use them immediately upon filing without prior approval.
A company that wants to set its rates outside this range must receive
the Commissioner´s prior approval.

Beneficiary
- The person, persons or entity designated to receive the death benefits
from a life insurance policy or annuity contract.

Binder - A temporary
insurance contract that provides proof of coverage until you receive
a permanent policy.

Bodily Injury (BI)
- Physical injury to a person.

CCancellation
- Termination of an insurance policy by the company or insured before
the renewal date.

Cash Surrender Option
- Nonforfeiture option, which specifies that the policy owner can cancel
the coverage and receive the entire net cash value in a lump sum.

Cash Value -
The amount of money, which the policy owner will receive as a refund
if the policy owner cancels the coverage and returns the policy to the
company. Also known as cash surrender value.

Churning - Can
occur when an agent persuades a consumer to borrow against an existing
life insurance policy to pay the premium on a new one.

Claimant - A
person who makes an insurance claim.

Co-insurance
- The percent of each health care bill you must pay out of your own
pocket. Non-covered charges and deductibles are in addition to this
amount.

Collision Coverage
- Pays for damage to your car without regard to who caused an accident.
The company must pay for the repair or up to the actual cash value of
your vehicle, minus your deductible.

Company Profile
- A synopsis of a company´s performance in the state of Texas.
Includes licensing data, a rating provided by A.M. Best Company, financial
information regarding the company´s assets and liabilities, complaint
history and a record of the companies activities as it pertains to the
interests it has in Texas.

Complaint -
The formal mechanism to start an investigation of potential wrongdoings
by insurers, agents and premium finance companies licensed and doing
business in the start of Texas.

Complaint History
- Information collected or maintained by the Texas Department of Insurance
relating to the number of justified, verified as accurate, and documented
as valid, complaints received against a particular insurer, agent or
premium finance company and the disposition of the complaints.

Comprehensive Coverage
(Physical Damage Other than Collision) - Pays for damage to
or loss of your automobile from causes other than accidents. These include
hail, vandalism, flood, fire, and theft.

Conditional Receipt
- A premium receipt given to an applicant which makes the insurance
effective only if or when a specified condition is met.

Contestable Period
- A period of up to 2 years that an insurance company may deny payment
of a claim because of suicide or a material misrepresentation on your
application.

Contingent Beneficiary
- Another party or parties who will receive the proceeds if the primary
beneficiary should predecease the person whose life is insured.

Contract - In
most cases, the term "contract" refers to an insurance policy.
A policy is considered to be a contract between the insurance company
and the policyholder.

Conversion Privilege
- The right to change (convert) insurance coverage from one type of
policy to another. For example, the right to change from an individual
term insurance policy to an individual whole life insurance policy.

Credit Life Insurance
- This is a special type of coverage usually designed to pay off your
loan or charge account balance if you die. Some lenders or sellers may
require credit life insurance before they will approve your loan. If
credit life is required, the lender or seller cannot require you to
purchase it from them or a particular insurance company. If you have
an existing life policy, the creditor has to accept an assignment of
benefits under your existing policy instead of requiring you to purchase
a credit life policy. Credit life insurance premium rates for loans
of 10 years or less are regulated by the Texas Department of Insurance,
but premium rates for loans that are more than 10 years old are unregulated.

DDeath Benefit
- Amount paid to the beneficiary upon the death of the insured.

Declarations Page
- - The page in your policy that shows the name and address of the insurer,
the period of time a policy is in force, a description of the vehicle,
the amount of the premium, and the amount of coverage.

Deductible -
The amount the insured must pay in a loss before any payment is due
from the company.

Deferred Annuity
- An annuity under which the annuity payment period is scheduled to
begin at some future date.

Depreciation
- The act of lowering an item´s value due to use or wear and tear.

Dividend - The
amount of money an insurance company may decide to distribute to policyholders.

EEarned Premium
- The portion of a policy premium that has been used to actually buy
coverage, or that the insurance company has "earned." For
instance, if you have a six-month policy that you paid for in advance,
two months into the policy, there would be two months of earned premium.
The remaining four months of premium is called unearned premium.

Effective Date
- The date on which an insurance policy becomes effective.

Endorsement
- A written agreement attached to a policy expanding or limiting the
benefits otherwise payable under the policy. Same as a "rider."

Escrow - Money
placed in the hands of a third party until specified conditions are
met.

Evidence of Insurability
- To qualify you for a particular policy at a particular price, companies
have the right to ask you for information about your health and lifestyle.
An insurance company will use this information - your evidence of insurability
- in deciding if your application for insurance is acceptable and at
what premium rate.

Exclusion -
Provision in an insurance policy that indicates what is denied coverage.

Experience Period
- The period of time that a company will reference when making evaluations
of an insuring policy. There is not a standardized amount of time. See
annotation for an example of an experience period.

Expiration Date
- The date on which an insurance policy expires.

Extended Term Insurance
Option - A nonforfeiture benefit under which the net cash value
of the policy is used to purchase term insurance for the amount of coverage
available under the original policy.

FFace Value
- The initial amount of death benefit provided by the policy as shown
on the face page of the contract. The actual death benefit may be higher
or lower depending on the options selected, outstanding policy loans
or premium owed.

First Party Loss
- A situation involving only the insurer and insured.

Free Examination Period
- Also known as "10-day free look" or "Free Look,"
it is the time period after a life insurance policy or an annuity is
delivered during which the policy owner may review it and return it
to the company for a full refund of the initial premium. Variable life
policies are required to include a "free-look" provision.
For other coverage, it is at the company´s option.

GGap Insurance
- Insurance that pays the difference between the actual cash value of
a vehicle and the amount still to be paid on the loan, Some gap policies
may also cover the amount of the deductible.

Grace Period(s)
- The time - usually 31 days - during which a policy remains in force
after the premium is due but not paid. The policy lapses as of the day
the premium was originally due unless the premium is paid before the
end of the 31 days or the insured dies. This is not a "free-insurance"
period.

Group Life Insurance
- This type of life insurance provides coverage to a group of people
under one contract. Most group contracts are sold to businesses that
want to provide life insurance for their employees. Group life insurance
also can be sold to associations to cover their members and to lending
institutions to cover the amounts of their debtor loans. Most group
policies are for term insurance. Generally, the business will be issued
a master policy and each person in the group will receive a certificate
of insurance.

Group of Companies
- Several insurance companies under common ownership and often common
management.

HHealth Maintenance Organization (HMO)
- Prepaid group health insurance plan which entitles members to services
of participating physicians, hospitals and clinics. Emphasis is on preventative
medicine.

Home Service Life
- Home service refers to a method of selling and servicing insurance,
mostly life and health insurance, and does not identify the type or
relative cost of the product that is sold. Some companies that market
on a home service basis sell what is known as "industrial life
insurance." These are most often low death benefit policies with
face amounts that may vary from $1,000 to $5,000 and which accumulate
cash values at a very low rate. They are intended primarily to cover
the expenses of a last illness and burial. The relative cost of industrial
life insurance is extremely high compared to some other cash value policies
and term life insurance policies.

IIncontestability
- A provision that places a time limit - up to two years - on a company´s
right to deny payment of a claim because of suicide or a material misrepresentation
on your application.

Independent Adjuster
- A person who charges a fee to the insurance company to adjust the
company´s claim.

Indexed Life Insurance
- A whole life plan of insurance that provides for the face amount of
the policy and, correspondingly, the premium rate, to automatically
increase every year based on an increase in the Consumer Price Index
(CPI) or another index as defined in the policy.

Insurable Interest
- A financial interest in the property insured, prerequisite to a valid
contract of insurance. In life insurance, a person´s or party´s
interest - financial or emotional - in the continuing life of the insured.
Insured - The person or firm covered by an insurance policy.

Insurer - The
insurance company.

Interpleader
- This is a procedure when conflicting claims are made on a life insurance
policy by two or more people. Using this procedure the insurance company
pays the policy proceeds to a court, stating the company cannot determine
the correct party to whom the proceeds should be paid.

Irrevocable Beneficiary
- A named beneficiary whose rights to life insurance policy proceeds
are vested and whose rights cannot be canceled by the policy owner unless
the beneficiary consents.

Liability Insurance
- Pays for injuries to the other party and damages to the other vehicle
resulting from an accident you caused. It also pays if the accident
was caused by someone covered by your policy, including a driver operating
your car with your permission.

Liability Limits
- The maximum amount your liability policy will pay. Your policy must
pay at least $20,000 per person for injuries and deaths, up to $40,000
for all victims of an accident, plus $15,000 for property damage. You
can purchase higher liability limits for additional premium.

Loss - The amount
an insurance company pays on a claim.

Loss History
- Refers to an insured´s history of losses (claims) with other
companies, or the company they are currently with. A company will consider
"loss history" when underwriting a new policy or considering
a renewal of an existing policy. Companies view "loss history"
as an indication of an insured´s propensity for a claim in the
future.

MMaterial Misrepresentation
- A significant misstatement in an application form. If a company had
access to the correct information at the time of application, the company
might not have agreed to accept the application.

Medical Payments &
Personal Injury Protection (PIP) - Both pay limited medical
and funeral expenses if you, a family member, or a passenger in your
car is injured or killed in a motor vehicle accident. PIP also pays
lost-income benefits.

Mortality Charge
- The cost of the insurance protection element of a universal life policy.
This cost is based on the net amount at risk under the policy, the Insured´s
risk classification at the time of policy purchase, and the Insured´s
current age.

Mortality Expenses
- The cost of the insurance protection based upon actuarial tables which
are based upon the incidence of death, by age, among given groups of
people . This cost is based on the amount at risk under the policy,
the insured´s risk classification at the time of policy purchase,
and the insured´s current age.

NNamed Driver Exclusion
- An endorsement that provides that a policy does not cover accidents
when a specifically named person is the driver.

Named Driver Policy
- A policy that covers only the drivers specifically named in the policy.
Generally, all other drivers are excluded from coverage under the policy.
This type of policy is usually written by surplus lines companies.

Net Cash Value
- The cash value amount available to a policy owner after adjustments
have been made to the cash surrender value to account for policy loans
and dividends.

Non-Owners Policy
- Insurance coverage that offers liability, uninsured motorist, and
medical payments to a named insured who does not own a vehicle.

Nonparticipating Policy
- A life insurance policy that does not grant the policy owner the right
to policy dividends.

Non-renewal
- A decision by an insurance company not to renew a policy.

O

PPaid-Up
- This event occurs when a policy will not require any further premiums
to keep the coverage in force.

Peril - A cause
of property losses. Usually used in the context of "a peril insured
against."

Policy - The
contract issued by the insurance company to the insured.

Policy Loan
- An advance made by a life insurance company to a policy owner. The
advance is secured by the cash value of the policy.

Policy Owner
- The person or party who owns an individual insurance policy. This
person may be the insured, the beneficiary or another person. The policy
owner usually is the one who pays the premium and is the only person
who may make changes to a policy.

Policy Period
- The period a policy is in force, from the beginning or effective date
to the expiration date.

Preferred Provider Organization
(PPO) - Hospital, physician, or other provider of health care
which an insurer recommends to an insured. A PPO allows insurance companies
to negotiate directly with hospitals and physicians for health services
at a lower price than would be normally charged.

Premium - The
amount paid by an insured to an insurance company to obtain or maintain
an insurance policy.

Premium
Expense Charges - An amount deducted from each premium payment,
which reduces the amount credited to the policy.

Property Damage (PD)
- Physical damage to property.
Providers - Usually references doctors or those who are providing a
medical service.

Public Adjuster
- A person hired by you to settle the claim with the insurance company
to settle the claim on your behalf.

Q

RRated Policy
- A policy issued at a higher premium to cover a person classified as
a greater-than-average risk, usually due to impaired health or a dangerous
occupation.

Redlining -
Refusal by an insurance company to underwrite or to continue to underwrite
questionable risks in a given geographical area.

Refund - Amount
of money being returned to the policyholder.

Reinstatement
- The process by which a life insurance company puts back in force a
policy which had lapsed because of nonpayment of renewal premiums.

Renewal Policy
- A policy issued as a renewal of a policy expiring in the same company
or agency; not new business.

Rental Reimbursement
Coverage - Pays a set daily amount for a rental car if your
car is being repaired because of damage covered by your auto policy.

Replacement Cost
- The cost associated with replacing property at current market prices.

Rescind - To
take away or remove. To avoid so as to restore the involved parties
to the positions they would have occupied had there been no contract.

Return Premium
- The premium returned to an insured for canceling or amending a policy.

Rider - A written
agreement attached to the policy expanding or limiting the benefits
otherwise payable under the policy. Same as an "endorsement."

Rule of 78 -
This is a method for calculating the amount of unused premium which
takes into account the fact that more insurance coverage is required
in the early months of the loan, since the payoff of the loan is greater.
As the loan is paid off, less coverage is being paid for, so the refund
percentage decreases.

Rule of Anticipation
- This is a similar method to "Rule of 78" where the amount
of unused premium takes into account the fact that more insurance coverage
is required in the early months of the loan, since the payoff of the
loan is greater. As the loan is paid off, less coverage is being paid
for, so the refund percentage decreases.

SSingle Interest Insurance
- Insurance coverage for only one of the parties having an insurable
interest in that property.

Single-Premium Whole
Life Policy - A type of limited-payment policy that requires
only one premium payment.

Suicide Clause
- Life insurance policy wording which specifies that the proceeds of
the policy will not be paid if the insured takes his or her own life
within a specified period of time after the policy´s date of issue.

Surcharge -
An extra charge added to your premium by an insurance company. For automobile
insurance, a surcharge is usually added if you have at-fault accidents.

Surplus Lines
- Coverage from out-of-state companies not licensed in Texas but legally
eligible to sell insurance on a "surplus lines" basis. Surplus
lines companies generally charge more than licensed companies and often
offer less coverage.

Surrender Charges
- Charges that are deducted if your life insurance policy or annuity
is cashed in (surrendered). These charges also are deducted if you borrow
money on your policy or if your policy lapses for non-payment.

TThird Party Administrator (TPA)
- An organization that performs managerial and clerical functions related
to an employee benefit insurance plan by an individual or committee
that is not an original party to the benefit plan.

Third Party Loss
- A situation involving a person other than the insurer and insured;
i.e., a person making a liability claim against the insured.

Towing and Labor Coverage
- Pays for towing charges when your car can´t be driven. Also
pays labor charges, such as changing a flat tire, at the place where
your car broke down.

UUnderwriter
- The person who reviews an application for insurance and decides if
the applicant is acceptable and at what premium rate.

Underwriting
- The process an insurance company uses to decide whether to accept
or reject an application for a policy.

Unearned Premium
- The insured´s remaining premium equity in his policy; that part
of the policy premium that has not been "used up."

Uninsured/Underinsured
Motorist (UM/UIM) Coverage - Pays for your injuries and property
damage caused by a hit-and-run driver or a motorist without liability
insurance. It will also pay when your medical and car repair bills are
higher than the other driver´s liability coverage.

Universal Life Insurance
- The key characteristic of universal life insurance is flexibility.
Within limits, you can choose the amount of insurance and the premium
you wish to pay. The policy will stay in force as long as the policy
value is sufficient to pay the costs and expenses of the policy. The
policy value is "interest-sensitive," which means that it
varies in accordance with the general financial climate. Lowering the
death benefit and raising the premium will increase the growth rate
of your policy. The opposite also is true. Raising the death benefit
and lowering the premium will slow the growth of your policy. If insufficient
premiums are paid, the policy could lapse without value before the maturity
date is reached. (The maturity date is the time your policy ceases and
cash surrender value would be payable if the policyholder is still living.)
Therefore, it is your responsibility to pay consistently a premium that
is high enough to ensure that your policy´s value will be adequate
to pay the monthly cost of the policy. The company is required to send
you an annual report and also to notify you if you are in danger of
losing your policy due to insufficient value.

Usual and Customary
- these charges may be based on: rates usually charged by physicians
and providers in your area; rate averages compiled by independent rating
services; or rate averages compiled by the insurance company.

VVariable Annuity
- A form of annuity policy under which the amount of each benefit payment
is not guaranteed and specified in the policy, but which instead fluctuates
according to the earnings of a separate account fund.

Variable Life Insurance
- A type of whole life policy in which the death benefit and the cash
value fluctuate according to the investment performance of a separate
account fund that the policyholder selects. Because the investment account
is regulated by the Securities and Exchange Commission, you must be
presented with a prospectus before you purchase a variable life policy.

Viatical Settlement Agreements
- Viatical settlements involve the sale of an existing life insurance
policy by a viator (person with a life threatening or terminal illness)
to a viatical settlement company in return for a cash payment that is
a percentage of the policy´s death benefit.

WWhole Life Insurance
- Whole life insurance policies are one type of cash value insurance.
Whole life policies offer protection through a lifetime - that is, for
a person´s "whole life." From the day you buy the policy,
you pay a scheduled premium,. The scheduled premium may be level or
may increase after a fixed time period, but it will not change from
the amount(s) shown in the policy schedule. It is important that you
look at the policy schedule to be sure you understand what your premium
payments will be and that you can afford them over time. This premium
is based on your age at the time of purchase. Initially, it will be
higher than the premium paid for a term policy, but you are likely to
end up paying less in premiums when you are older, if you keep the policy
for a long time. Part of each premium payment will go to cash value
growth, part for the death benefit and part for expenses (such as commissions
and administrative costs). There is no need to renew whole life policies.
As long as you pay your premium when due, your coverage will continue
in force throughout your life.